Trends in Prepregnancy Cardiometabolic Health in Rural and Urban Areas in the United States, 2016-2023.

Abstract

<b>Objectives.</b> To describe differences in prepregnancy cardiometabolic health in the United States by urbanicity from 2016 to 2023. <b>Methods.</b> We included 29 087 432 pregnant individuals 15 to 44 years old with data in the Centers for Disease Control and Prevention Natality Files. We calculated age-standardized trends in prepregnancy cardiometabolic health from 2016 to 2023 by urbanicity using the cardiovascular-kidney-metabolic (CKM) staging system (stage 0 [no risk factors], stage 1 [overweight/obesity], and stage 2 [diabetes or hypertension]). We used prevalence ratios to compare annual prevalence by urbanicity. <b>Results.</b> From 2016 to 2023, the prevalence of prepregnancy CKM stage 0 decreased in rural and urban areas, whereas the prevalence of stages 1 and 2 increased. Specifically, stage 0 decreased from 41.5% (95% confidence interval [CI] = 41.4%, 41.7%) to 35.6% (95% CI = 35.4%, 35.7%) in rural areas and from 48.2% (95% CI = 48.1%, 48.3%) to 40.7% (95% CI = 40.6%, 40.7%) in urban areas. Prevalence ratios for stages 0 through 2 in 2016 were 0.86 (95% CI = 0.86, 0.87), 1.12 (95% CI = 1.11, 1.12), and 1.36 (95% CI = 1.34, 1.39), respectively, in rural relative to urban areas and remained stable over the study period. <b>Conclusions.</b> In this national sample, prepregnancy cardiometabolic health decreased from 2016 to 2023 in urban and rural communities and exhibited a persistent gap, with rural areas more severely affected. (<i>Am J Public Health</i>. 2026;116(3):372-375. https://doi.org/10.2105/AJPH.2025.308299).